The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders

Grilo, Carlos M.; Sanislow, Charles A.; Shea, M. Tracie; Skodol, Andrew E.; Stout, Robert L.; Pagano, Maria E.; Yen, Shirley; McGlashan, Thomas H.

doi:10.1002/eat.10196

Cited by 63 publications

(36 citation statements)

References 53 publications

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“…However, Milos et al 3 found that only 22% of those with AN and 31% of those with BN showed remission over a 2.5-year period. Another study indicated that 40% of the patients with BN recovered over a 2-year follow-up 8 and 74% had recovered by 5-year follow-up. 6 Eddy et al 4 found that 46% of patients with restricting AN and 39% of patients with binge/ purge AN achieved recovery over a period of 8 years.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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Eat ing disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are one of the most prevalent psychiatric problems for girls and young women, result in subjective distress and functional impairment, and increase risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems. 1,2 Although these eating disorders are clearly associated with functional impairment, less is known about the course of these eating disorder diagnoses over time. The purpose of this commentary is to discuss the findings of two articles on the longitudinal course of eating disorder diagnoses that appear in this special issue to discuss implications for nosology, and to offer suggestions regarding future research in this area.Long-term Stability of Eating Disorder Diagnoses (Fichter, & Norbert) This manuscript reports data on the stability of eating disorders over a 12-year period in a large treatment sample (N 5 311). Assessments were conducted at the beginning of therapy and at 2-year, 6-year, and 12-year follow-ups. The 12-year stability rate was 41.4% for AN, 34.4% for BN, 3.0% for BED, and 3.2% for other eating disorder not otherwise specified diagnoses (EDNOS). Results suggest moderate longitudinal instability of AN and BN, and pronounced longitudinal intability of BED and other EDNOS conditions. This instability was due to recovery, relapse, and diagnostic crossover. Most crossovers occurred from AN to BN and from BED to BN. Long-term outcome for BN and BED was encouraging, with both showing high recovery rates. The long-term outcome for AN was worse relative to BN and BED. Furthermore, the longitudinal course of BN and BED seemed to be nearly identical with similar percentages of remission and relapse. Relapse rates were low in this treatment sample.Before discussing the implications of these findings for nosology and future research directions, it is important to compare the findings from this study with other studies that have been previously published. Although research indicates that the overarching diagnosis of ''eating disorder'' is relatively stable, 3 several studies suggest that there is considerable longitudinal instability of the specific eating disorder diagnoses of AN, BN, and EDNOS in treatment samples, resulting from recovery, relapse, and crossover between and within the eating disorder diagnoses. 3,4-6 The recovery rates for AN and BN were moderate to high at each of the follow-up assessments in Fichter and Quadflieg study, which is similar to the rates reported by 7 who found that at 5-year follow-up, 56% of patients with AN, 74% of patients with BN, and 78% of patients with EDNOS no longer met criteria for any eating disorder diagnosis.Recovery rates of other treatment studies, however, are somewhat lower. For example, Fichter and Quadflieg reported a remission rate of 43.8% in AN and 56.8% in BN over a 2-year period; these recovery rates increased to about 60% for AN and about 70% for BN over a 6-12-year period....

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Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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“…The Collaborative Longitudinal Personality Disorders Study (Gunderson et al, 2000) is a prospective study on the course of four PDs. One report from that study (Grilo et al, 2003) concluded that the natural course of BN and eating disorders not otherwise specified (EDNOS) was not influenced by PDs.…”

Section: Introductionmentioning

confidence: 97%

Two-year prospective study of personality disorders in adults with longstanding eating disorders

Rø

Martinsen

Hoffart

et al. 2005

Int. J. Eat. Disord.

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“…There were no feasible design options to ameliorate this. Recent evidence supports remission of bulimia nervosa in untreated female cases over 24 months (Grilo et al, 2003). However, this study did not find reductions in the bulimia subscale of the EAT-26 over follow-up of between 12 and 24 months in either the treated or treatment as usual group.…”

Section: Study Limitationsmentioning

confidence: 76%

“…Patients with eating disorder and PD have been found to be characterized by chronicity and lower levels of functioning (Skodol et al, 1993) and have poorer outcomes following treatment for their eating disorder than eating-disordered patients without comorbid PD (Johnson, Tobin, & Dennis, 1990;Rossiter, Agras, Telch, & Schneider, 1993). This negative has been shown across a range of treatment approaches, including cognitive behavioural therapy (CBT) (Fahy et al, 1993), pharmacological and combined pharmacological/CBT treatment (Rossiter et al, 1993) and group interpersonal therapy (Wilfley et al, 2000), although the conclusiveness of the evidence for this with respect to bulimia nervosa has been questioned (Bell, 2002;Grilo et al, 2003). It has been recommended that all bulimic patients should be assessed for PD as a matter of routine (Rosenvinge et al, 2000).…”

Section: Introductionmentioning

confidence: 95%

Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorder

Warren

Zaman

Dolan

et al. 2006

Eur. Eat. Disorders Rev.

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Objective: To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance. Method: Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up. Results: There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response. Conclusion: Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder.

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The natural course of bulimia nervosa and eating disorder not otherwise specified is not influenced by personality disorders

Cited by 63 publications

References 53 publications

Stability of eating disorder diagnoses: A commentary

Stability of eating disorder diagnoses: A commentary

Two-year prospective study of personality disorders in adults with longstanding eating disorders

Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorder

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